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Olajubu EA, Aliyu E, Aderounmu AG, Hamidja KB. Managing E-Patient Case Notes in Tertiary Hospitals. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2021. [DOI: 10.4018/ijhisi.295823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Telemedicine is the use of information and communication technologies to extend healthcare work to the vulnerable in the rural areas. It is unfortunate that telemedicine is yet to be deployed in sub Sahara Africa where there is acute shortage of medical professionals with many rural dwellers without medical facilities. This paper proposes an electronic Patient’s Case-Note to replace existing manual method so as to mitigate the challenges associated with manual record keeping. The tree theory was used to motivate the information follows which the basis for the theoretical framework for the study also presented is the Cyclic structure that depicts information flow in the system. The conceptual model and the algorithms to implement the model are presented. The Model was implemented and few screenshot presented.
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Tummers J, Tekinerdogan B, Tobi H, Catal C, Schalk B. Obstacles and features of health information systems: A systematic literature review. Comput Biol Med 2021; 137:104785. [PMID: 34482198 DOI: 10.1016/j.compbiomed.2021.104785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Currently many healthcare systems are supported by an increasing set of Health Information Sys-tems (HISs), which assist the activities for multiple stakeholders. The literature on HISs is, however, fragmented and a solid overview of the current state of HISs is missing. This impedes the understanding and characterization of the required HISs for the healthcare domain. METHODS In this article, we present the results of a Systematic Literature Review (SLR) that identifies the HISs, their domains, stakeholders, features, and obstacles. RESULTS In the SLR, we identified 1340 papers from which we selected 136 studies, on which we performed a full-text analysis. After the synthesis of the data, we were able to report on 33 different domains, 41 stakeholders, 73 features, and 69 obstacles. We discussed how these domains, features, and obstacles interact with each other and presented suggestions to overcome the identified obstacles. We recognized five groups of obstacles: technical problems, operational functionality, maintenance & support, usage problems, and quality problems. Obstacles from all groups require to be solved to pave the way for further research and application of HISs. CONCLUSION This study shows that there is a plentitude of HISs with unique features and that there is no consensus on the requirements and types of HISs in the literature.
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Affiliation(s)
- J Tummers
- Information Technology Group, Wageningen University & Research, Hollandseweg 1, 6706, KN, Wageningen, the Netherlands.
| | - B Tekinerdogan
- Information Technology Group, Wageningen University & Research, Hollandseweg 1, 6706, KN, Wageningen, the Netherlands.
| | - H Tobi
- Biometris, Wageningen University & Research, Droevendaalsesteeg 1, 6708, PB, Wageningen, the Netherlands.
| | - C Catal
- Department of Computer Science and Engineering, Qatar University, 2713, Doha, Qatar.
| | - B Schalk
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, Route 68, 6500, HB, Nijmegen, the Netherlands.
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Ciampi M, Esposito A, De Pietro G, Masciari E, Sicuranza M. Big Data and Health Care: a lesson learned. 2018 IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE (BIBM) 2018. [DOI: 10.1109/bibm.2018.8621169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Sittig DF, Wright A, Ash J, Singh H. New Unintended Adverse Consequences of Electronic Health Records. Yearb Med Inform 2016:7-12. [PMID: 27830226 DOI: 10.15265/iy-2016-023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user experiences; inadvertent disclosure of large amounts of patient-specific information; increased focus on computer-based quality measurement negatively affecting clinical workflows and patient-provider interactions; information overload from marginally useful computer-generated data; and a decline in the development and use of internally-developed EHRs. While each of these new UACs poses significant challenges to EHR developers and users alike, they also offer many opportunities. The challenge for clinical informatics researchers is to continue to refine our current systems while exploring new methods of overcoming these challenges and developing innovations to improve EHR interoperability, usability, security, functionality, clinical quality measurement, and information summarization and display.
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Affiliation(s)
- D F Sittig
- Dean F. Sittig, University of Texas Health Science Center at Houston, School of Biomedical Informatics, and UT-Memorial Hermann Center for Health Care Quality, and Safety, Houston, Texas, USA, E-mail:
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Hugonnet S, Eggimann P, Borst F, Maricot P, Chevrolet JC, Pittet D. Impact of Ventilator-Associated Pneumonia on Resource Utilization and Patient Outcome. Infect Control Hosp Epidemiol 2015; 25:1090-6. [PMID: 15636298 DOI: 10.1086/502349] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractObjective:To assess the effect of ventilator-associated pneumonia on resource utilization, morbidity, and mortality.Design:Retrospective matched cohort study based on prospectively collected data.Setting:Medical intensive care unit of a university teaching hospital.Patients:Case-patients were all patients receiving mechanical ventilation for 48 hours or more who experienced an episode of ventilator-associated pneumonia. Control-patients were matched for number of discharge diagnoses, duration of mechanical support before the onset of pneumonia among case-patients, age, admission diagnosis, gender, and study period.Results:One hundred six cases of ventilator-associated pneumonia were identified in 452 patients receiving mechanical ventilation. The matching procedure selected 97 pairs. Length of stay in the intensive care unit and duration of mechanical ventilation were greater among case-patients by a mean of 7.2 days (P< .001) and 5.1 days (P< .001), respectively. Median costs were $24,727 (interquartile range, $18,348 to $39,703) among case-patients and $17,438 (interquartile range, $12,261 to $24,226) among control-patients (P< .001). The attributable mortality rate was 7.3% (P = .26). The attributable extra hospital stay was 10 days with an extra cost of $15,986 per episode of pneumonia.Conclusion:Ventilator-associated pneumonia negatively affects patient outcome and represents a significant burden on intensive care unit and hospital resources.
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Affiliation(s)
- Stéphane Hugonnet
- Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
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Hannan TJ, Celia C. Are doctors the structural weakness in the e-health building? Intern Med J 2014; 43:1155-64. [PMID: 24134174 DOI: 10.1111/imj.12270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 07/15/2013] [Indexed: 11/29/2022]
Abstract
Progressive evaluations by the Organization for Economic Co-operation and Development (OECD) demonstrate that health care is now or becoming unaffordable. This means nations must change the way they manage health care. The costly nature of health care in most nations, as a percentage of Gross Domestic Product (GDP) seems independent of the national funding models. Increasing evidence is demonstrating that the lack of involvement by clinicians (doctors, nurses, pharmacists, ancillary care and patients) in e-health projects is a major factor for the costly failures of many of these projects. The essential change in focus required to improve healthcare delivery using e-health technologies has to be on clinical care. To achieve this change clinicians must be involved at all stages of e-health implementations. From a clinicians perspective medicine is not a business. Our business is clinical medicine and e-health must be focussed on clinical decision making. This paper views the roles of physicians in e-health structural reforms.
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Affiliation(s)
- T J Hannan
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
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Ciampi M, De Pietro G, Esposito C, Sicuranza M, Donzelli P. On federating Health Information Systems. 2012 INTERNATIONAL CONFERENCE ON GREEN AND UBIQUITOUS TECHNOLOGY 2012. [DOI: 10.1109/gut.2012.6344168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Hannan T, Brooks P. Health workforce changes and the roles of information technology associated with these changes. “The Times They Are A-Changin' ” (Bob Dylan, 1964). Intern Med J 2012; 42:722-7. [DOI: 10.1111/j.1445-5994.2012.02801.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Murthy A, De Angelis G, Pittet D, Schrenzel J, Uckay I, Harbarth S. Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 2010; 16:1747-53. [DOI: 10.1111/j.1469-0691.2010.03220.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Becker J, Janiesch C. Restrictions in Process Design: A Case Study on Workflows in Healthcare. BUSINESS PROCESS MANAGEMENT WORKSHOPS 2008. [DOI: 10.1007/978-3-540-78238-4_34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cruz-Correia RJ, Vieira-Marques PM, Ferreira AM, Almeida FC, Wyatt JC, Costa-Pereira AM. Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs. BMC Med Inform Decis Mak 2007; 7:14. [PMID: 17565667 PMCID: PMC1919361 DOI: 10.1186/1472-6947-7-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 06/12/2007] [Indexed: 11/10/2022] Open
Abstract
Background The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS. Methods The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing. Results Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters. Conclusion It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.
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Affiliation(s)
- Ricardo J Cruz-Correia
- Department of Biostatistics and Medical Informatics, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Centre for Research in Health Technologies and Information Systems – CINTESIS (Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde), Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Pedro M Vieira-Marques
- Department of Biostatistics and Medical Informatics, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Centre for Research in Health Technologies and Information Systems – CINTESIS (Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde), Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana M Ferreira
- Department of Biostatistics and Medical Informatics, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Centre for Research in Health Technologies and Information Systems – CINTESIS (Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde), Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Filipa C Almeida
- Department of Biostatistics and Medical Informatics, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Centre for Research in Health Technologies and Information Systems – CINTESIS (Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde), Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Jeremy C Wyatt
- Health Informatics Centre, University of Dundee, Dundee, Scotland, UK
| | - Altamiro M Costa-Pereira
- Department of Biostatistics and Medical Informatics, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Centre for Research in Health Technologies and Information Systems – CINTESIS (Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde), Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Brazhnik O, Jones JF. Anatomy of data integration. J Biomed Inform 2007; 40:252-69. [PMID: 17071142 PMCID: PMC2094006 DOI: 10.1016/j.jbi.2006.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 09/11/2006] [Accepted: 09/19/2006] [Indexed: 01/23/2023]
Abstract
Producing reliable information is the ultimate goal of data processing. The ocean of data created with the advances of science and technologies calls for integration of data coming from heterogeneous sources that are diverse in their purposes, business rules, underlying models and enabling technologies. Reference models, Semantic Web, standards, ontology, and other technologies enable fast and efficient merging of heterogeneous data, while the reliability of produced information is largely defined by how well the data represent the reality. In this paper, we initiate a framework for assessing the informational value of data that includes data dimensions; aligning data quality with business practices; identifying authoritative sources and integration keys; merging models; uniting updates of varying frequency and overlapping or gapped data sets.
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Affiliation(s)
- Olga Brazhnik
- Center for Information Technology, National Institutes of Health, 10401 Fernwood Road, Room 3NW03, Bethesda, MD 20817, USA.
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Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R. Incidence of hip fracture over a 10-year period (1991-2000): reversal of a secular trend. Bone 2007; 40:1284-9. [PMID: 17292683 DOI: 10.1016/j.bone.2006.12.063] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 12/14/2006] [Accepted: 12/21/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hip fractures are a major cause of burden associated with osteoporosis in terms of mortality, disability, and costs. With the ageing of the population, a marked increase in the number of fractures is expected. Furthermore, many studies reveal an increase of the age-adjusted hip fracture incidence. We specifically examined secular changes in the incidence of hip fracture in women and men aged 50 years and over in the well-defined area of Geneva, Switzerland. MATERIALS AND METHODS All hip fractured patients were retrospectively identified from the computer medical records of the main hospital, which is receiving 95% of hip fractures occurring in a well-defined area. RESULTS From 1991 to 2000, 4115 hip fractures were recorded in 2981 women and 822 men with a mean age (+/-S.D.) of 83.1+/-8.9 and 78.3+/-11.6 years, respectively. A second hip fracture occurred in 276 women (9.3%) and 36 men (4.4%), on average 2.1+/-1.9 (median 1.44) years after the first event without gender difference. The overall incidence of hip fractures was 455 (95% CI: 439-471) per 100,000 person-years in women and 153 (95% CI: 143-163) in men. The number of hip fractures remained constant (412 (95% CI: 397-426)), but the mean age of these patients increased each year by 0.13 year in women (p=0.019) and by 0.04 year in men (NS). Furthermore, the age-adjusted incidence of hip fractures, standardized to the 2000 Geneva population, decreased significantly by 1.4% (95% CI: -2.6 to -0.1) per year in women (p=0.021), but remained stable in men (0.5% (95% CI: -1.7 to +2.8) per year, p=0.66). The overall female/male ratio of hip fracture incidence was 2.99 (95% CI: 2.80-3.18, p<0.001) and significantly decreased by 0.07 (95% CI: -0.13 to -0.01) per year (p=0.024). CONCLUSION Despite an increase in the population at risk and in the mean age of hip fractured women, there was a significant decrease in age-adjusted incidence in women but not in men. These results may suggest a reversal of the previously observed secular trend.
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Affiliation(s)
- T Chevalley
- Service of Bone Diseases and Geriatric Evaluation Unit, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, CH-1211 Geneva 14, Switzerland.
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Jolliet P, Tassaux D, Roeseler J, Burdet L, Broccard A, D'Hoore W, Borst F, Reynaert M, Schaller MD, Chevrolet JC. Helium-oxygen versus air-oxygen noninvasive pressure support in decompensated chronic obstructive disease: A prospective, multicenter study. Crit Care Med 2003; 31:878-84. [PMID: 12627000 DOI: 10.1097/01.ccm.0000055369.37620.ee] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, PaCO2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization costs. DESIGN Prospective, randomized, multicenter study. SETTING Intensive care units of three tertiary care university hospitals. PATIENTS All patients with chronic obstructive pulmonary disease admitted to the intensive care units for NIPSV during a 24-month period. INTERVENTIONS Patients were randomized to NIPSV with air/oxygen or He/oxygen. NIPSV settings, number of daily trials, decision to intubate, and intensive care unit and hospital discharge criteria followed standard practice guidelines. RESULTS A total of 123 patients (male/female ratio, 71:52; age, 71 +/- 10 yrs, Acute Physiology and Chronic Health Evaluation II, 17 +/- 4) were included. Intubation rate (air/oxygen 20% vs. He/oxygen 13%) and length of stay in the intensive care unit (air/oxygen 6.2 +/- 5.6 vs. He/oxygen 5.1 +/- 4 days) were comparable. The post-intensive care unit hospital stay was lower with He/oxygen (air/oxygen 19 +/- 12 vs. He/oxygen 13 +/- 6 days, p < .002). Cost of NIPSV gases was higher with He/oxygen, but total hospitalization costs were lower by $3,348 per patient with He/oxygen. No complications were associated with the use of He/oxygen. CONCLUSION He/oxygen did not significantly reduce intubation rate or intensive care unit stay, but hospital stay was shorter and total costs were lower. He/oxygen NIPSV can be safely administered and could prove to be a cost-effective strategy.
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Affiliation(s)
- Philippe Jolliet
- Medical Intensive Care Division, University Hospital, Geneva, Switzerland
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Lovis C, Baud RH, Planche P. Power of expression in the electronic patient record: structured data or narrative text? Int J Med Inform 2000; 58-59:101-10. [PMID: 10978913 DOI: 10.1016/s1386-5056(00)00079-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper presents the authors' experience with the development and use of a document-centered electronic patient record (EPR) in a large teaching hospital. The development of the document-centered EPR began with the formulation of a set of critical hypotheses to facilitate both the continuation of the best medical practice and the implementation and use of the EPR. An alternate and more conventional approach - the data-centered EPR - is compared with the document-centered EPR. Various benefits and pitfalls are discussed. Finally, the choice was to offer both solutions in a tightly linked system. The need for an EPR which combines the document and data centered approaches is a reflection of the more general discussion of what the medical record will be in the future. All too often, the need for structured data conflicts with the need for free texts and the power of expression. It is not easy to evaluate the consequences of this initial decision. However, changing the foundations of the EPR after its implementation is difficult and expensive. Therefore, the selection of the correct orientation in a given hospital requires a broad-based discussion.
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Affiliation(s)
- C Lovis
- Health Services Research and Development Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA
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